V patterns Esotropia and Exotropia and their management by Dr Sudhir Singh

Strabismus

Strabismus is defined as a misalignment of the eyes. Strabismus also called as squint.
Orthophoria – Implies as perfect ocular alignment without efforts.
Strabismus consists of two subgroups.
1.Hetrotropia – this is a manifest squint.
Esotropia – deviation of eye towards inside.
Exotropia -- deviation of eye towards towards outside.
Hypertropia-- deviation of eye towards upside.
2.Hetrophoria—this is a latent ocular deviation. Eye alignment is maintained with fusional effort.
Esophoria – inward deviation of eye when fusion is disrupted.
Exophoria-- outward deviation of eye when fusion is disrupted.
Hyperphoria-- upward deviation of eye when fusion is disrupted.
Incyclophoria-- Intortional movement of eye when fusion is disrupted.
Excyclophoria-- Extortional movement of eye when fusion is disrupted.

Concomitant Strabismus
Esotropia
Exotropia
Non Comitantant Strabismus ( Paralytic)
Third Nerve Palsy
Forth Nerve Palsy
Sixth Nerve Palsy
Non Comitantant Strabismus ( Restrictive)
Duane’s Retraction Syndrome
Brown Syndrome
Double Elevator Palsy

Infantile Esotropia

A Pattern Deviations

V Pattern Deviations

Restictive Thyroid Myopathy

How to examine a strabismus patient?

Management Of Eso Deviations

Complications Of Strabismus (Squint) Surgery

Esotrpoia With A Patterns

If esotropia is atleast 10 prism diopter more in up gaze ( 25 degree up) than the down gaze (35 degree) then it called as A pattern esotropia.

Causes of A -pattern strabismus

Superior oblique muscle overaction
Relative underaction of the Inferior oblique muscles


	Fig1. Esotropia in up gaze ( Pic. Curtsey Dr Sudhir Singh)

	Fig2.Esotropia in primary gaze ( Pic. Curtsey Dr Sudhir Singh)


	Fig3. Straight eye in down gaze ( Pic. Curtsey Dr Sudhir Singh)

Management Of A-Pattern strabismus

Surgical treatment of Exotropia with A -pattern strabismus with Superior oblique muscle overaction

Lateral rectus muscle recessions with superior oblique muscle weakening
Lateral rectus muscle recession with Medial rectus resection with superior oblique muscle weakening

Surgical treatment of Exotropia with A-pattern strabismus without superior oblique muscle overaction

Bilateral lateral rectus muscle recessions with down shift

Lateral rectus muscle recessions with down shift + medial rectus muscle resections with up shift

Exotropia with V-pattern - Bilateral medial rectus muscle resections with upshift

Surgical treatment of Esotropia with A-pattern strabismus with superior oblique muscle overaction

Medial rectus muscle recessions with superior oblique muscle weakening
Medial rectus muscle recession with lateral rectus resection with superior oblique muscle weakening

Surgical treatment of Esotropia with A-pattern strabismus without oblique muscle overaction

Bilateral medial rectus muscle recessions with upshift

Bilateral lateral rectus muscle resections with down shift

Medial rectus muscle recessions with upshift + lateral rectus muscle resections with down shift

Download Patient Case Sheet Performa In Word Format

References

Download Free Trial Version Of Strabismus Software "SquintMaster Software"

Strabismus or Squint Software called SquintMaster

Salient Features Of SquintMaster Software

Designed and Developed By Dr Sudhir Singh ,M.S

Suggests diagnosis and sub type of deviations
Important tool for patient counseling
Suggests surgical options
Creates simulated image of deviations
With help of squint simulator and calculator user can calculate surgical dose ( Amount of surgery)
AC /A Simulator And Calculator
A V Patterns Simulator And Calculator
Parks 3 Step Test
Knapp's Classification
Simulator for ductions, versions and grades of oblique muscles over action
Classification and management of Duane's Retraction Syndrome
Management of third nerve palsy
Management of forth nerve palsy
Management of sixth nerve palsy
Management of Browns Syndrome
Management of double elevator palsy